We are saddened by the recent death of Professor James Shepherd who amongst his many contributions was a key driver in the foundation of The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) in 1995 and an important presence long term but especially during its early activities.He was awarded Honorary Membership of the Society in 1996.Jim Shepherd was a world pioneer in the investigation of the causes, prevention and treatment of coronary heart disease.His interest in science was evident early in his life when he dissected animals in the kitchen, performed chemistry experiments at home and injured himself making a rocket in the family garage.He attended the University of Glasgow graduating
Objective To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes. Methods In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994–1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death. Results Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05–1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04–1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04–2.33; P = 0.03). Conclusions Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.
1. All previous studies on the effects of changes in sodium intake on the renal dopamine (DA) response (increase in urinary DA output) have used sudden, large changes in oral sodium intake. The present study was designed to study the role of renal DA and the suppression of sympathetic nervous system activity in the natriuretic response to step-wise, gradual increases in sodium intake. 2. Seven healthy, male Chinese subjects (23-25 years) were studied. During the 12-day study period (day -3 to 8), subjects were given the same basic diet containing 1900 calories, 75 g protein, 20 mmol sodium and 45 mmol potassium. From days 1 to 8, subjects also received 'Slow sodium' tablets (Ciba-Geigy) equivalent to 50 mmol on day 1, 100 mmol on day 2, 150 mmol on day 3,200 mmol on day 4, 250 mmol on day 5, and 300 mmol on days 6 to 8. Body weight was recorded and blood pressure was measured after lying supine for 10 min in the morning before breakfast on entry and at the end of the low and high sodium intake periods. Urine was collected for 24 h on day -3 and from days 0 to 8 for the measurement of sodium, potassium, creatinine, free DA and free noradrenaline (NA). 3. After 4 days of sodium restriction, mean arterial pressure (mean +/- SEM) had decreased from 83.0 +/- 1.3 to 79.4 +/- 0.5 (P < 0.05) and body weight from 70.2 +/- 3.1 to 68.3 +/- 3.0 (P < 0.02). Following sodium loading, MAP and body weight did not change, but pulse rate had decreased from 64.1 +/- 2.8 to 57.4 +/- 2.6 (P < 0.02). 4. There was a 13-fold increase in sodium excretion (P < 0.02) by the last day of the high sodium intake period. There were no significant changes in urine volume and urinary excretion of potassium, creatinine and free DA throughout the high sodium intake period. In contrast, there was a 19.9-26.5% decrease in urine NA 4 and 6 days after the start of the increase in sodium intake. 5. Healthy Chinese subjects do not have a renal DA response to gradually increasing sodium intake over an 8-day period. Any tendency to hypervolaemia-related rises in blood pressure during the high sodium intake period may be partly offset by a reduction in sympathetic nervous system activity.
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